Preventive and abortive treatment of migraine with traditional drugs. The state of the art / Tratamento preventivo e abortivo da enxaqueca com medicamentos tradicionais. O Estado da arte

Introduction: Migraine is a chronic neurological disease, with a prevalence of 15.2% in Brazil. It is 2.2 times more prevalent in women, predominantly in the 18-50 age group. Its pathophysiological mechanism is still not completely understood. Possibly headache attacks and symptoms are associated with cortical spreading depression, the trigeminovascular system, neurogenic inflammation, vasodilation and genetic vulnerability. Objective:This is a narrative review of preventive and abortive treatment of migraine. Comment: Migraine treatment is based on three pillars: patient education, treatment of the disease itself or prevention of attacks, and acute treatment of headache attacks. The therapeutic classes of traditional drugs used in migraine prevention are beta-blockers, tricyclic antidepressants, calcium channel antagonists or blockers, and anticonvulsant neuromodulators. Specific drugs used in the treatment of headache attacks are triptans or serotonergic 5-HT1B/1D receptor agonists, ditans or 5-HT1F receptor agonists, and gepants or CGRP receptor antagonists. Conclusion: Traditional drugs used in the preventive or abortive treatment of migraine are considered to be effective. Through modulation of the disease mechanisms, there is a reduction in the frequency, intensity and duration of headache attacks, and also in the disability caused by the headache. All this to improve the quality of life of patients. The therapeutic classes of traditional drugs used in migraine prevention are beta-blockers, tricyclic antidepressants, antagonists or blockers of calcium channels and anticonvulsant neuromodulators. Specific drugs used in the treatment of headache attacks are triptans or serotonergic 5-HT1B/1D receptor agonists,ditans or 5-HT1F receptor agonists, and gepants or CGRP receptor antagonists.

Introdução: A enxaqueca é uma doença neurológica crônica, com prevalência de 15,2% no Brasil. É 2,2 vezes mais prevalente em mulheres, predominantemente na faixa etária de 18 a 50 anos. Seu mecanismo fisiopatológico ainda não está completamente esclarecido. Possivelmente, os ataques e sintomas de dor de cabeça estão associados à depressão alastrante cortical, ao sistema trigeminovascular, à inflamação neurogênica, à vasodilatação e à vulnerabilidade genética. Objetivo: Esta é uma revisão narrativa do tratamento preventivo e abortivo da enxaqueca. Comente: O tratamento da enxaqueca baseia-se em três pilares: educação do paciente, tratamento da própria doença ou prevenção de crises e tratamento agudo das crises de cefaleia. As classes terapêuticas de medicamentos tradicionais utilizados na prevenção da enxaqueca são betabloqueadores, antidepressivos tricíclicos, antagonistas ou bloqueadores dos canais de cálcio e neuromoduladores anticonvulsivantes. Os medicamentos específicos utilizados no tratamento de crises de dor de cabeça são triptanos ou agonistas do receptor serotoninérgico 5-HT1B/1D, ditans ou agonistas do receptor 5-HT1F e gepants ou antagonistas do receptor CGRP. Conclusão: Os medicamentos tradicionais utilizados no tratamento preventivo ou abortivo da enxaqueca são considerados eficazes. Através da modulação dos mecanismos da doença, há redução na frequência, intensidade e duração das crises de cefaleia, e também na incapacidade causada pela cefaleia. Tudo isso para melhorar a qualidade de vida dos pacientes. As classes terapêuticas de medicamentos tradicionais utilizados na prevenção da enxaqueca são betabloqueadores, antidepressivos tricíclicos, antagonistas ou bloqueadores dos canais de cálcio e neuromoduladores anticonvulsivantes. Os medicamentos específicos utilizados no tratamento de crises de cefaleia são triptanos ou agonistas do receptor serotoninérgico 5-HT1B/1D, ditans ou agonistas do receptor 5-HT1F e gepants ou antagonistas do receptor CGRP.

Clinical features and orbital anomalies in Fraser syndrome and a review of management options

Purpose: Fraser syndrome is a rare congenital disorder comprising cryptophthalmos, syndactyly, and many times, urogenital anomalies. Herein, the authors aimed to study and report the clinical features and orbital anomalies in cases diagnosed with Fraser syndrome. Methods: The authors retrospectively evaluated the records of patients with Fraser syndrome who had presented to a tertiary eye care hospital in northern India in the last 2 years (from January 2019 to December 2020). The clinical features were studied, entered in MS Excel, and the data was evaluated. Results: Data of 15 patients with Fraser syndrome were found. Majority of the patients were males and presented in the pediatric age group. Bilateral involvement was more common, and the most common variant of cryptophthalmos was abortive. Complete and medial madarosis of the eyebrows was the most common periocular finding. Complete cryptophthalmos was associated with cystic globes, whereas abortive forms had superior symblepharon. Common systemic features included syndactyly, bifid nose, and urogenital anomaly. Conclusion: Fraser syndrome is an extremely rare developmental disorder; it encompasses a wide range of ocular, periocular, and orbital anomalies, along with multiple pre?existing systemic anomalies. The treating ophthalmologist should always be careful in examining these patients

Tessier cranio-facial clefts presenting to a tertiary eye care center in Northern India: Ophthalmic features and a review of management

Purpose: Tessier classification is used to classify congenital facial cleft disorders utilizing the anatomical location of the cleft and its extension. The orbital and ocular morbidities associated with the birth disorder are numerous. The authors decided to perform a retrospective analysis of the clinical features of the patients who presented to a tertiary care hospital with orbito?cranial clefts. Methods: The authors retrospectively evaluated the records of patients with craniofacial clefts who had presented to a tertiary eye care hospital in northern India in the last 2 years (January 2019–December 2020). The clinical features were studied, entered in MS Excel, and the data were evaluated. Results: The data of 40 patients with Tessier cleft were found. The majority of the patients were male and presented in the pediatric age group. Unilateral involvement was more common, with maxillary hypoplasia being the most common facial anomaly associated. Eyelid coloboma and euryblepharon was the most common periocular finding; lateral epibulbar dermoid and corneal opacity were the most common ocular surface anomaly. The majority of patients had presented for cosmetic correction. The syndromic association was with Goldenhar syndrome (n = 13), Fraser (n = 2), and one each of Treacher Collins, blepharocheilodontic, organoid nevus, and oculo?dento?digital syndrome. Combined clefts were also seen. Conclusion: Tessier cleft classification is a useful tool to classify cranio?facial left anomalies. Multitudes of ocular and orbital anomalies can be associated with their different forms. Better knowledge and understanding of the classification will aid immensely in predicting the ocular defects and planning their management

Os riscos do uso de plantas medicinais durante o período gestacional: uma revisão bibliográfica / The risks of the use of medicinal plants during the gestational period: A bibliographic review

Esta revisão de literatura teve como objetivo principal identificar as plantas medicinais utilizadas por gestantes capazes de provocar efeitos nocivos à gestação, assim como descrever os principais metabólitos secundários responsáveis por estes efeitos. Foram utilizados artigos escritos entre os anos de 2011 e 2018, disponíveis em bases de dados eletrônicas como Scielo, Periódicos Capes, Lilacs, Medline e Science Direct. Foram selecionadas 98 publicações, destas 52 foram excluídos por apresentarem problemas metodológicos ou não se adequarem ao tema, sendo 46 artigos aproveitados. Foram apresentadas as plantas medicinais frequentemente utilizadas por mulheres durante o período gestacional, as quais acredita-se não provocarem danos a gestação. Plantas como boldo, sene, camomila, carqueja, angélica, arruda e outras são comumente utilizadas pela população gestante a fim de aliviar os desconfortos desse período, como enjoo, flatulência, insônia, azia, depressão, insônia, dores articulares, emagrecimento, dentre outros. No entanto, as plantas medicinais possuem metabólitos secundários que são considerados tóxicos e capazes de provocar efeitos embriotóxico, teratogênico e abortivo, quando utilizados durante a gestação. Diante do que foi pesquisado, avaliando a relação risco/benefício, onde os estudos apontam muitos riscos oferecidos pelas plantas medicinais utilizadas na gestação, sugere-se o uso controlado destes tratamentos durante o período gestacional com o devido acompanhamento médico.

This literature review had as main objective to identify the medicinal plants used by pregnant women capable of causing harmful effects to gestation, as well as to describe the main secondary metabolites responsible for these effects. Articles used in this review were written between the years 2011 and 2018 and are available in electronic databases such as Scielo, Periodical Capes, Lilacs, Medline and Science Direct. A total of 98 publications were selected, of which 52 were excluded because they presented methodological problems or did not fit the theme, with 46 articles being used. The medicinal plants frequently used by women during the gestational period were shown, which are believed not to cause pregnancy damage. Plants such as boldo, sene, camomile, carqueja, angelica, arruda and others are commonly used by the pregnant population to relieve the discomforts of this period, such as nausea, flatulence, insomnia, heartburn, depression, joint pain, weight loss, among others. However, medicinal plants have secondary metabolites that are considered to be toxic and capable of causing embryotoxic, teratogenic and abortive effects when used during pregnancy. In the light of the research, evaluating the risk / benefit relationship, where the studies point out many risks offered by the use of medicinal plants during pregnancy, it is suggested controlled use of these treatments during the gestational period with the appropriate medical follow-up.

Effects of Anzi Mixture on TLR4/MyD88/NF-κB Signaling Pathway of Antiphospholipid Antibodies Posi-tive Abortive Mice / 中国药房

OBJECTIVE:To study the effects of Anzi mixture on Toll like receptor 4(TLR4)/myeloid differentiation factor 88 (MyD88)/nuclear facter-κB(NF-κB)signaling pathway of antiphospholipid antibodies(APA)positive abortive mice,and to inves-tigate the mechanism of anti-APA positive abortion. METHODS:BALB/c mice(female)were randomly divided into blank control group,model group,aspirin group (positive control,0.0195 g/kg) and Anzi mixture low-dose,medium-dose and high-dose groups (37.7,75.4,150.8 g/kg,calculated by crude drug),with 10 mice in each group. Except for blank control group,other groups were given human β2-glycoprotein Ⅰ as derivant to establish APA positive abortion model. From the first day of pregnancy, treatment groups were given relevant medicine intragastrically,and blank control group and model group were given constant vol-ume of normal saline intragastrically,once a day,for consecutive 9 d. mRNA and protein levels of TLR4,myeloid differentiation 2 (MD2),MyD88 and NF-κB in placental tissue of mice were determined by RT-PCR and immunohistochemical method. RE-SULTS:Compared with blank control group,mRNA and protein expression of TLR4,MD2,MyD88 and NF-κB in placental tis-sue were increased markedly in the model group(P<0.01). Compared with model group,mRNA and protein expression of TLR4, MD2 and MyD88 in aspirin group and Anzi mixture low-dose and medium-dose groups were decreased significantly as well as the protein expression of TLR4 in Anzi mixture high-dose group and the protein expression of NF-κB in all medicine groups(P<0.05 or P<0.01). mRNA expression of TLR4 and MD2 and the protein expression of MD2 and MyD88 in Anzi mixture low-dose groups were lower than those in aspirin group (P<0.05 or P<0.01). CONCLUSIONS:Anzi mixture can inhibit TLR4/MyD88/NF-κB signaling pathway of APA positive abortive mice,which may be one of anti-APA positive abortion mechanisms.

Effect of Simultaneous Administration of Oral Polio Vaccine on Local Reaction of BCG Vaccine in Term Infants.

Objective: To study local reaction and to ascertain timing of scar formation in infants after BCG vaccination at birth, with and without simultaneous administration of trivalent OPV. Design: Prospective observational study. Setting: Teaching hospital in Lucknow, India. Participants: 152 term neonates born in the hospital and given BCG and OPV 0-dose simultaneously before discharge, within 7 days of birth (Group I) , and 122 infants born at home or in private health facility, not given OPV-0 dose, coming for vaccination within 7 days of age (Group 2). Intervention/Observation: Follow up done at 6 week, 10 week, 14 week and 9 months. Local reaction was recorded at the site of BCG vaccination. Results: Scar formed in ≤14 wks in 51.3% and 89.3% babies in Group 1 and Group 2, respectively following BCG vaccination (P<0.001). At 9 months, scar developed in 93.9% infants in Group I and 94.3% babies in Group II. Abortive reaction and nonreactors were similar in both groups (P>0.05). Conclusions: Simultaneous administration of BCG vaccine with trivalent OPV to term infants in early neonatal period prolongs the time of scar formation but sequence of local reaction is not affected.

Drug Therapy for Migraine

Migraine significantly disturbs the quality of life of the patients by causing severe throbbing headache associated with neurological, autonomic, and gastrointestinal symptoms. Management of migraine starts from the correct diagnosis based on the classification proposed by the International Headache Society in 2004. Treatment failure and medication overuse and abuse commonly result from misdiagnosis of specific type of headache. Treatment includes: (1) nonpharmacological therapy (patient education, regular exercise, abstinence of caffeine and alcohol drinking, avoidance of fasting, and regular sleep), (2) acute pharmacological therapy (simple analgesics, NSAIDs, ergotamines, triptans, etc.), and (3) prophylactic pharmacological therapy (beta- blockers, calcium channel blockers, antidepressants, and anticonvulsants). Because individual drugs have their unique properties and drug interactions, careful selection and combination of the drugs must be made on the basis of the patient's migraine type, associated symptoms, and comorbidities. One of the complications of migraine drug therapy is transformation of episodic migraine into chronic daily headache that is caused by abuse or overuse of anti-migraine drugs. So the correct diagnosis of migraine and appropriate pharmacological and non-pharmacological treatments are of utmost importance in improving the patient's quality of life and prevention of medication-overuse headache.

Clinicopathologic observation of the severe recision rupture following radial keratotomy / 眼科新进展

Objective　To investigate clinical manifestation and pathologic changes of corneal incision rupture at different stages and the cause of incision rupture after abortive trauma.Methods　Three removal eyeball obtained from RK for severe incision rupture by abortive trauma were fixed with formalin, embedded with paraffin, sected stained by HE and observed under light microscope.Results　The eyeball distorted, intraocular structure disordered and vision lost severely in 3 eyes. Epithelial plugs were found in superficial layer of stroma and Bowman's layer broke and displaced in three cases. Healing and gap of incision presented 29 days after RK in 1 case. There were incision scar, collagen disarrangement and epithelial island in deep incision more than 2 years following RK in two cases, descent's layer broke in 1 case.Conclusion　RK can weaken the eye which will rupture easily and their visual function will be disturbed severely after abortive trauma.

Hyperthermia during General Anesthesia: A case report / 대한마취과학회지

The fulminant malignant hyperthermia (MH) is now encountered less frequently because of increased awareness of the condition by anesthesiologist and better use of mornitoring facilities. Thus there is also an increase in the number of aborted cases, in which anesthesia is stopped and treatment instituted as soon as MH is thought to be likely. We presented a case of an abortive MH in 18 years old male patient during the discectomy on the third and fourth lumbar intervertebral spaces. Anesthesia was induced with thiopental sodium and succinylcholine and then maintained with nitrous oxide, oxygen and enflurane. After induction, there were persistent tachycardia, elavation of end-tidal CO2 tension on capnography, spontaneous tachypnea, body temperature elevation up to 38.2oC, respiratory acidosis and highly level of CPK, myoglobulin in serum and urine. Under the suspicion of MH, all anesthetics were discontinued and vigorous emergency treatment was attempted including ventilation with high flow of 100% oxygen (8 l/min), changing all anesthetic circuits, and cooling measurements such as chilled intravenous solution infusion, gastric lavage with cold saline, alcohol and ice water pack over the body. Fourtunately, he recovered well and discharged without complications.

Promoter search and strength of a promoter: two important means for regulation of gene expression in Escherichia coli.

Search for a promoter element by RNA polymerase from the extremely large DNA base sequence is thought to be the slowest and rate-determining for the regulation of transcription process. Few direct experiments we described here which have tried to follow the mechanistic implications of this promoter search. However, once the promoter is located, transcription complex, constituting mainly the RNA polymerase molecule and few transcription factors has to unidirectionally clear the promoter and elongate the RNA chain through a series of steps which altogether define the initiation of transcription process. Thus, it appears that the promoter sequence acts as a trap for RNA polymerase associated with a large binding constant, although to clear the promoter and to elongate the transcript such energy barrier has to be overcome. Topological state of the DNA, particularly in the neighbourhood of the promoter plays an important role in the energetics of the whole process.

Myoglobinuria Following General Anesthesia / 대한마취과학회지

The authors experienced a case of myoglobinuria accompanied by generalized myalgia and mild fever that developed 3 hours 30 minutes after general anesthesia. Tracheal intubation was done smoothly 5 minutes after injection of thiopental sodium(275 mg) and pancuronium bromide(6 mg), and anesthesia was maintained with ethrane/N2O/O2(1.5-2%/21/21/min). There was no specific event except tachycardia and fluctuation of blood pressure throughout operation. In this case, we assume that the myoglobinuria is a presentation of the sign of an abortive type of malignant hyperthermia. However, it was not confirmed. We had good patient outeome with the supportive measures of hydration and diuresis. The patient was discharged twenty three days after operation without any complication.

Design of rotation ring for rotating abortive apparatus / 医疗卫生装备

This paper introduces the operational principle, structure, components of rotating abortive apparatus. The structure, size, material and design of the rotation ring are presented, and the abortion with rotating abortive apparatus is also mentioned in this paper.